Relationship of nicotine deprivation and indices of alcohol use behavior to implicit alcohol and cigarette approach cognitions in smokers

Abstract

Alcohol and smoking frequently co-occur and alcohol is a primary trigger for smoking behavior and relapse back to smoking. This study examined whether several indices of alcohol use behavior and consequences of use would be associated with changes in implicit alcohol-approach versus implicit cigarette-approach cognitions under cigarette deprived and non-deprived cognitions in a 109 smokers who drank at risky or non-risky levels. An Implicit Association Task (IAT) measured how quickly respondents paired alcohol and cigarette pictures with approach and avoid words. Regression analyses examined the associations of quantity/frequency, proportion heavy drinking days, number of DSM-IV alcohol use disorder (AUD) symptoms, and risky drinking status to IAT scores under deprived conditions, controlling for IAT order effects, non-deprived IAT score, and deprived cigarette craving and withdrawal. Interactions with craving and withdrawal intensity were also examined. Results showed a significant positive association between proportion of heavy drinking days and stronger alcohol-approach than cigarette-approach motivations when deprived. There was also a conditional association of AUD symptoms to alcohol-approach motivations among respondents reporting more intense withdrawal when deprived. Alcohol quantity and frequency, as well as risky drinking status were unrelated to change in IAT scores. Findings suggest that cigarette deprivation may magnify motivation to drink, rather than smoke, among smokers who engage in more frequent bouts of heavy drinking and who report more alcohol-related problems. Results also show relative momentary and unconscious “preference” or choice for alcohol over cigarettes in some high-risk smokers, when cigarette craving and withdrawal are high.

The Role of Implicit and Explicit Staff Attitudes in the Use of Coercive Measures in Psychiatry

“…Previous research from different fields has been trying to link implicit and explicit attitudes to actual behavior (43)(44)(45), with moderate success. Until today, it seems difficult to explain the gap between people's attitudes and actual behavior (46).…”

Assessment of Automatically Activated Approach–Avoidance Biases Across Appetitive Substances

“…[32, 54, 55•]), but importantly these were the studies that did not observe an approach bias for the disorder-related substance. Finally, the experimental studies highlighted a number of moderators that strengthened approach bias and its relationship with consumption behaviour, such as relevant task instructions [48, 80••], negative or positive affect [64,65,66••], low cognitive load [68], hunger [78] and withdrawal from other substances [71]. Together, these findings support the main premises of dual-process models of behaviour, namely, that automatically activated tendencies predict behaviour when the reflective system is relatively weak (e.g.…”

“…Another challenge for the understanding of automatically activated approach-avoidance tendencies is co-morbidity. Indeed, research examined in this review highlighted that tobacco and alcohol use were interrelated [35,71]. Thus, another direction for future research is the concurrent assessment of approach-avoidance biases and related behaviours for multiple substances.…”

“…Research has also examined the moderating role of substance use in the relationship between approach bias and consumption behaviour. Cohn et al [71] found that approach bias toward alcohol, but not cigarette cues, predicted proportion of heavy drinking days during nicotine deprivation. Their findings suggest that cigarette withdrawal may increase motivation to drink, but not smoke.…”

How Will Alcohol Research be Impacted by Future Reduction in Nicotine Content in Cigarettes?

“…To our knowledge, this is the only study that has examined the effects of prolonged nicotine reduction (i.e., 6 weeks) on alcohol drinking. Past studies of acute nicotine deprivation or abstinence have reported inconsistent effects on alcohol craving and drinking behavior (Cooney et al, 2003, Colby et al, 2004, Cohn et al, 2017, Palfai et al, 2000), but these studies may not closely model what is expected to occur in the marketplace as a result of new FDA product standards – a gradual reduction in nicotine content in cigarettes. As we anticipate changes in nicotine content in cigarettes, it is now time to reflect on how alcohol-focused researchers, clinicians, and policy makers, who have had a long-standing focus on harm reduction, can prepare for upcoming changes in the nicotine-focused harm reduction regulatory framework for tobacco.…”